Thesis (MScPhysio)--Stellenbosch University, 2004. / ENGLISH ABSTRACT: Muscle weakness is a problem for many young people with spastic cerebral palsy (CP). Many studies have reported that selective strength-training programs can improve muscle strength. However, most of these studies are of single group design and do not adequately control for confounding variables. Objective: To determine the impact of a comprehensive strength training program targeting multiple muscle groups on adolescents with CP, using basic inexpensive free weights and resistance devices. Method: A randomised clinical trial evaluated the effects of an eight-week strength-training program on 31 independently ambulant adolescents with spastic CP, with or without walking aids, from Eros School (19 males, 12 females; mean age 16 years 1 month; range 13 - 18 years). The Kin-Com dynamometer, 3-D gait analysis, the Economy of Movement test and a questionnaire was used to evaluate selected muscle strength, the degree of crouch gait, free walking velocity and stride length, energy consumption during walking and perceptions of body image and functional competence. Twenty one subjects took part in the strength-training program and were compared with 10 control subjects. Results were analysed using repeated measures ANOVA and bootstrap analysis. Results: Compared with the control, significant improvement in the degree of crouch as measured by the sum of the ankle, knee and hip angles at midstance (p=0.05) and perceptions of body image (p=0.01) were noted for the experimental group. Significant trends were also noted for isometric knee extension muscle strength at 30° as well as for hip abduction at 10° and 20°. Walking efficiency, -velocity and stride length remained unchanged as well as perceptions of functional ability. Conclusion: A strength-training program targeting multiple muscle groups including upper and lower limbs as well as the trunk, can lead to changes in muscle strength and improve the degree of crouch gait with improved perception of body image. Successful participation in such a program at school may motivate children with CP to continue with home-based basic strength training. Strength training alone did not decrease oxygen consumption during walking and inclusion of aerobic exercise is recommended. / AFRIKAANSE OPSOMMING: Spierswakheid is 'n probleem vir baie jong mense met serebrale verlamming (SV). Navorsing het getoon dat selektiewe versterkende oefenprogramme selektiewe spiere kan versterk, maar die meeste studies bestaan uit 'n enkel groep met onvoldoende beheer oor verstrengelde veranderlikes. Doel: Om die impak van 'n omvattende versterkende oefenprogram met basiese, goedkoop gewigte en weerstandsaparaat wat vele spiergroepe teiken, op adolesente met spastiese SV te evalueer. Metodologie: Die effekte van 'n agt weke lang versterkende oefenprogram is op 31 onafhanklik mobiel adolesente met spastiese SV, met of sonder loophulpmiddel, van Eros Skool deur middel van 'n ewekansige kliniese proef geevalueer (19 manlike, 12 vroulike deelnemers; gemiddelde ouderdom 16 jaar 1 maand; omvang 13 - 18 jaar). Die Kin-Com dinamometer, "3-D gait analysis", die "Economy of Movement" toets en 'n vraelys is gebruik om geselekteerde spiersterkte, die hoeveelheid knie fleksie gesien in die onderste ledemaat tydens loop, loopspoed en treelengte, energieverbruik tydens loop asook persepsies van liggaamsbeeld en funksionelevermoë te evalueer. Een en twintig het in die versterkende oefenprogram deelgeneem en is met 10 kontrole deelnemers vergelyk. Resultate is met behulp van herhaalde metings "ANOVA" en "bootstrap analysis" geanaliseer. Resultate: In vergelyking met die kontrole groep, het die experimentele groep betekenisvolle verbetering getoon in die hoeveelheid fleksie gesien in die ondersteledemaat (p=0.05) soos bereken deur die som van die enkel-, knie- en heuphoek in midstaan fase tydens loop, asook in liggaamspersepsie (p=0.01). Beduidenisvolle tendense is ook gesien by die experimentele groep vir isometriese knie ekstensie spiersterkte by 30° asook vir heup abduksie by 10° en 20°. Energieverbruik tydens loop asook loopspoed en treelengte was onveranderd asook persepsie van funksionele vermoë. Gevolgtrekking: 'n Versterkende oefenprogram wat verskeie spiergroepe teiken, insluitende die onderste en boonste ledemate asook die romp, kan lei tot In verbetering in spiersterkte, minder fleksie in die onderste ledemate tydens loop asook 'n verbetering in ligaamspersepsie. Suksesvolle deelname aan so 'n program op skool, mag kinders dalk motiveer om In basiese versterkende oefenprogram tuis voort te sit. Versterkende oefening alleen het geen vermindering in suurstofverbruik tydens loop veroorsaak en die insluit van aerobiese oefening word aanbeveel.

Temos aktualumas: Cerebrinis paralyžius (CP) – tai neprogresuojantis galvos smegenų pažeidimas, atsiradęs galvos smegenyse prenataliniu, perinataliniu, neonataliniu ar postnataliniu laikotarpiu. Cerebrinis paralyžius apibūdinamas kaip būklė, kuriai būdingas raumenų silpnumas, nekoordinuoti judesiai ir/arba kitokie motorinių funkcijų sutrikimai, sukelti dar nesubrendusių vaiko smegenų pažeidimo. Nuo CP kenčiančio vaiko judėjimas (gulėjimas, sėdėjimas, vartymasis, vaikščiojimas) yra sutrikęs. Vaiko raumenų tonusas gali būti sumažėjęs arba padidėjęs, susijęs su pusiausvyros ir koordinacijos problemomis. CP neretai lydi motorinės (judesių) kontrolės, raumenų jėgos, sensorinės (jutiminės) integracijos ir judesio planavimo sutrikimai, taip pat fizinis ir funkcinis pajėgumas. Fizinis pajėgumas bei aktyvumas yra pagrindinis organizmo augimo bei tobulėjimo stimuliatorius. Kiekviena judėjimo forma optimizuoja žmogaus ne tik motorikos, bet ir jo psichinės bei socialinės brandos vyksmą. Labai svarbu, kad vaikai turintys CP galėtų siekti fizinio ir funkcinio gebėjimo panašiai kaip ir įprastai besivystantys vaikai. Tyrimo dalyviai: 10 vaikų su CP. Probleminiai klausimai: koks vaikų su CP fizinis pajėgumas? Koks vaikų su CP funkcinis pajėgumas? Ar yra ryšys tarp vaikų su CP fizinio ir funkcinio pajėgumo? Probleminiai klausimai įgalino iškelti kryptingą hipotezę: tikėtina, kad vaikų su CP funkcinis pajėgumas priklauso nuo fizinio pajėgumo. Tyrimo objektas –fizinis ir funkcinis pajėgumas... [toliau žr. visą tekstą] / Topic relevance: Cerebral Palsy (CP) – non-progressive brain violation, which develops during Prenatal, Perinatal, Neonatal, Post-natal period. Muscle weakness, uncoordinated movements and/or other motor function disorders are the state of the immature brain sufferers of CP. Movements, such as lying, sitting, tumbling, hiking, are malfunctioning for those who has CP. Muscle tone of the child (that relates to balance and coordination problems) can be decreased or increased. CP often comes along with motor (movement) control, muscle strength, sensory integration, and movement planning problems as well as physical and functional capacity weakness. Physical capacity and activity are the main stimulus of the body whilst growing. Each and every movement optimizes not only motor movements, but also psychological and social pubescence. It is important that those who have CP would have an ability to achieve and aim same physical and functional ability exactly the same like those who progress and develop normally. Participants of the research: 10 children with CP. Questions to research: what is the physical capacity of those who have CP? What is the functional capacity? What is the connection amongst CP physical and functional capacity? Hypothesis made out of those questions: it is believed that CP functional capacity is depends on the physical capacity. Object of the research – physical and functional capacity. Aim of the research – find out the physical and functional capacity of... [to full text]

An innovative Partially Immersed Approach, based on mixed principles of land and aquatic therapy theories was developed to enhance sitting adaptation and functioning in an Aquatics Therapy environment, thus improving quality of life for children with Cerebral Palsy. The approach aimed to enhance motor adaptation, engendering adaptation in psychosocial domains of quality of life. It employed a specially developed therapeutic treatment chair, in an unloading toward loading strategy, to regulate and control percentage of weight-bearing by manipulation of buoyancy (Archimedes principle). Participants were bilateral spastic hypertonia, Cerebral Palsy children, aged 10-15 years. Mixed-method methodology was used to investigate effectiveness of treatment, employing a small sample in a multiple case study. In conclusion, the developed approach enables aquatic therapy to be employed to improve motor function adaptation on land and consequently enhancing adaptation in other psychosocial domains - perceived competence, empowerment and motivation - thus improving quality of life for children with cerebral palsy, sustained at a one-year post-intervention test.

Descriptions of obesity, cerebral palsy, and scoliosis were rank-ordered (from one to twenty) and rated on a five-point scale by 75 college students. The descriptions were of two types: with the appearance of an individual on five levels of severity of a disorder and with the appearance and level of functioning of an individual on five levels of severity of a disorder. The ranking data indicated males rank-ordered descriptions of obese individuals different from cerebral palsy (p < 0.01) and scoliosis (p < 0.05) . The ratings of the descriptions were analyzed in two studies with 2 x 2 x 2 x 5 ANOVA's. Three-way interactions of the level of severity, complexity of description, and type of disorder rated were discussed in terms of likeability of handicapped individuals .

The field of augmentative and alternative communication (AAC) has evolved since the 1970s, consequently there now exists a group of adults with cerebral palsy (CP), in the UK, who are life-time users of AAC prescribed as an intervention for their complex communication impairments. Ten adults, aged between 20-55 years, participated in conversations about their unique life experiences and aspirations, using AAC, including voice output communication aids (VOCAs). The ability and opportunity to interact and communicate personal accounts has significance for conceptualizing outcomes of intervention. Clinical practice informed this research project. A qualitative research design was employed to explore questions about the extent to which adult aided communicators talk about their lives, aspirations and opinions; the past life experiences participants talk about and finally how they talk about their quality of life. Conversational-styled, semi-structured interviewing using literature-guided questions yielded rich interactional data. A discourse analytical approach to the 34 interviews was taken. Findings identified a number of ordinary interactional features and discourses. Aided communicators used multimodal communication to interact and converse, positioning through their contributions as assertive speakers and engaged recipients. Interactional turns were managed with participants using unaided communication signals as conversational continuers. Participants demonstrated how to manage others who speak on their behalf. Examples of interactional repair were noted when participants pre-empted breakdown. Managing novel utterances was a feature with unexpected responses challenging the listener’s position. Participants constructed VOCA-mediated utterances to share long-term memories, worries, satisfaction with life, and aspirations. Aspirations included community ambitions and creating fulfilling daily lives. Some participants expressed frustration but balanced this against a position of contentment. Some participants also demonstrated personal responsibility and positioned themselves through their talk as contributors to communities. Recommendations for clinical practice are suggested that include the provision of adult clinical services and interaction focused intervention for adult aided communicators with cerebral palsy.

Title: Using Virtual Reality as a Therapeutic Modality for Children with Cerebral Palsy: a Review and Synthesis Author: Bc. Petra Smolová Grammar correction: Jan Valeška Background: Cerebral palsy is often referred to as an" umbrella term" denoting a group of non-progressive conditions involving primarily a disorder of voluntary movement and/or co-ordination. A functional impairment is more important than diagnosis itself, due to the lifelong type of the disease. Therapy in children suffering from CP is nowadays based on individual movement therapy within a whole complex of rehabilitation programmes. The first line of treatment is building up an interdisciplinary team of professionals, led by paediatrics neurologist or neurologist who is pursuing rehabilitation. Physical therapist should always choose an eclectic approach, knowing only too well the reasons why. Virtual reality as a therapeutic modality is standing besides classic methods according to various authors, as we know from schools and different courses. However, this kind of treatment is novel, its results are greatly promising based on current research. Aim: The purpose of this thesis is to outline the use of virtual reality as a method of therapy in children with cerebral palsy in the main functional conditions - motor control, upper...

Title: Massage as a mean of a compensation of graphomotor performance by children with Cerebral Palsy. Objective: The objective of diploma thesis is to verify a positive effect of relaxing massage by children with Cerebral Palsy relate to current graphomotor performance. Methods: The work is conceived as intraclass experimental research. The pre-test and the post-test is carried out by means of the selected items Ozeretzkij's test and the Test of circles and the Test of waves. Results: The methods used in the research did not prove the relationship between the use of the relaxing massage and the current graphomotorics performance by children with cerebral palsy. Key words: graphomotoric, cerebral palsy, relaxing massage, effects of massage

Title: The use of music therapy for physically disabled Author: Bc. Jan Janyška Leading: Mgr. Barbara Valešová Malecová, Ph. D. Summary The thesis is trying to clarify the base of constantly developing discipline called music therapy, specifically music therapy for people with specific needs. In the introduction the psychological value of physical disability is mentioned with a focus on a cerebral palsy. The theoretical chapter is dealing with an impact of sound on a human body considering the music therapy. Practical part is focused on designing a music therapy plan which was subsequently applied in practice with physically disabled people. Key words Physical disability, cerebral palsy, sound, music, music therapy

Call number: LD2668 .P7 1973 J65

Este estudo teve por objetivo realizar a validação da versão brasileira do Spinal Alignment and Range of Motion Measure - SAROMM para uso junto à população brasileira de crianças e adolescentes com Paralisia Cerebral. MÉTODO: Trata-se de um estudo metodológico, transversal, desenvolvido em três etapas: ETAPA I: Fidedignidade da SAROMM-Br (Confiabilidade Interexaminadores) - participaram 25 crianças/adolescentes com paralisia cerebral (PC), distribuídas em cada nível de classificação motora de acordo com a GMFCS-E&R. ETAPA II: Validade discriminante da SAROMM-Br entre crianças com PC e crianças com desenvolvimento típico (DT) - participaram 50 crianças/adolescentes, sendo 25 crianças/adolescentes com PC e 25 com DT; e entre os diferentes níveis motores (GMFCSE&R) de crianças/adolescentes com PC - participaram 100 crianças/adolescentes com PC, sendo 20 de cada nível motor do GMFCS-E&R. ETAPA III: Validade Concorrente entre a SAROMM-Br e Escala de Deficiências de Tronco (EDT) e entre a SAROMM-Br e a função motora (GMFM-66) - participaram 50 crianças/adolescentes com PC. As crianças/adolescentes com PC foram avaliadas no Centro Integrado de Reabilitação do Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto - CIR e na Clínica de Fisioterapia do Centro Universitário Barão de Mauá (CBM) no Ginásio de Neurologia, e as crianças/adolescentes com desenvolvimento típico (DT) foram avaliadas na CBM e no Vie Instituto de Habilitação Funcional. RESULTADOS: Na ETAPA I: a pontuação total e as médias de todas as variáveis da SAROMM apresentaram concordância alta ou quase perfeita (CCC - 0,981- 0,998). Na ETAPA II: as crianças/adolescentes com DT apresentaram as médias das variáveis da SAROMM-Br próximas de 0 (zero), significativamente menores que as médias das crianças/adolescentes com PC, sendo que estas apresentam maior variabilidade e dispersão de seus valores. As variáveis pontuação total SAROMM-Br e ADM total apresentam maior potencial discriminante entre os níveis de GMFCS-E&R, sendo capaz de distinguir crianças/adolescentes entre todos os níveis, exceto entre os níveis I e II, e nível II e III. Já a variável Média Tornozelo possui menor potencial discriminante entre os níveis de GMFCS-E&R, sendo capaz de discriminar apenas as crianças/adolescentes nível V dos demais níveis. Na ETAPA III: as correlações entre GMFM-66, pontuação total da SAROMMBr, médias coluna, joelho, membros superiores e total ADM foram consideradas boas a excelentes (-0.76-0.89). A correlação entre GMFM-66 e a variável média quadril da SAROMM-Br foi considerada moderada à boa. Entretanto, a correlação da GMFM-66 com a variável tornozelo da SAROMM-Br foi considerada pobre. As correlações entre a pontuação total da SAROMM-Br, ADM total da SAROMM-Br e total da EDT foram consideradas boas a excelentes (-0.78-0.80). Em relação às variáveis específicas da SAROMM-Br, as médias de coluna, membros superiores, e total ADM apresentaram melhores correlações, de moderada a excelente, com as variáveis estático (-0.78-0.84), dinâmico (-0,65-0,75), coordenação (-0,74- 0.79) e pontuação total da EDT (-0,78-0.84). A variável média de tornozelo da SAROMM-Br foi a que deteve correlações consideradas mais baixas com as variáveis EDT (-0.14-0.21). CONCLUSÃO: A SAROMM-Br é um instrumento confiável e válido para avaliar crianças/adolescentes brasileiros com PC de diferentes níveis motores e tipos clínicos. / This study aimed to validate the Brazilian version of the Spinal Alignment and Range of Motion Measure - SAROMM for use in the Brazilian population of children and adolescents with Cerebral Palsy. METHOD: This is a cross-sectional, methodological study developed in three stages: STAGE I: Reliability of SAROMM-Br (Inter-Relay Reliability) - 25 children / adolescents with cerebral palsy (PC) participated in each level of motor classification accordance with GMFCS-E & R. STAGE II: Discriminant validity of SAROMMBr among children with CP and children with typical development (DT) - 50 children / adolescents participated, 25 children / adolescents with CP and 25 with DT; and between the different motor levels (GMFCS-E & R) of children / adolescents with PC - participated 100 children / adolescents with PC, 20 of each GMFCS-E & R motor level. STAGE III: Competitive Validity between SAROMM-Br and Trunk Deficiency Scale (EDT) and between SAROMM-Br and motor function (GMFM-66) - 50 children / adolescents with PC participated. The children / adolescents with CP were evaluated at the Integrated Rehabilitation Center of the Hospital das Clínicas of the Ribeirão Preto Medical School (CIR) and at the Physiotherapy Clinic of the Barão de Mauá University Center (CBM) at the Gymnasium of Neurology, and the children / adolescents with typical development (TD) were evaluated in the CBM and in the Vie Instituto de Habilitação Funcional. RESULTS: In STAGE I: the total score and means of all SAROMM variables presented high or near perfect agreement (CCC - 0.981-0.998). In STAGE II: the children / adolescents with TD presented the means of the variables of the SAROMM-Br close to 0 (zero), significantly lower than the means of the children / adolescents with CP, being that they present greater variability and dispersion of their values. The variables total score SAROMM-Br and total ADM present a greater discriminant potential between the levels of GMFCS-E & R, being able to distinguish children / adolescents between all levels, except between levels I and II, and level II and III. The mean ankle variable has a lower discriminant potential between GMFCS-E & R levels, being able to discriminate only children / adolescents level V of the other levels. In STAGE III: correlations between GMFM-66, total SAROMM-Br score, median spine, knee, upper limb and total ADM were considered good to excellent (-0.76-0.89). The correlation between GMFM-66 and the median variable of SAROMM-Br was considered moderate to good. However, the correlation of GMFM-66 with the anomalous variable of SAROMM-Br was considered poor. Correlations between total SAROMM-Br score, total SAROMM-Br and ADM and total EDT score were considered good to excellent (-0.78-0.80). In relation to the SAROMM-Br specific variables, the mean values of the spine, upper limbs, and total ADM presented better correlations, moderate to excellent, with the variables static (-0.78-0.84), dynamic (-0.65-0, 75), coordination (-0.74-0.79) and total EDT score (-0.78-0.84). The average ankle variable of SAROMM-Br was the one that had correlations considered lower with the EDT variables (-0.14-0.21). CONCLUSION: SAROMM-Br is a reliable and valid instrument to evaluate Brazilian children / adolescents with PCs of different motor levels and clinical types.